li 118 31illllll!llllllll~lll decembr 199 - dtic · "ad-a256 118 vri-dmis-2.60 j....

VRI-DMIS-2.60 WN91-5"AD-A256 118 J. Hufford

li 31illllll!llllllll~lll Decembr 199

DTiCTOCT 2 1992

UPDATING DoD MEDICAL TREATMENT

FACILITY (MTF) PEER GROUPS

lZ/i

92 10 0 42S92-26338

VECTOR RESEARCH, INCORPORATEDP.O. Box 1506

Ann Arbor, Michigan 48106(313) 973-9210

31 December 1991

4. TTLE A,",ID SU3TITL. 3. , :' ,.J

UPDATING DOD MEDICAL TREATMENT FACILITY (MTF) PEER GROUPS MDA903-88-C-0147

Vector Research, IncorporatedTask Order Proponent: Stuart W. Baker, LTC, MS, USA

7. PLIFOR2,1ING C3,GANIZATiCA N'A.E(S) AND ADOIRE6S(:S) 23. PE rT.•222. G A C NGAIZA rICN7r E PC R" 7 N;U'A 3'- RVECTOR RESEARCH, INCORPORATED

P.O. Box 1506 VRI-DMIS-2.60 WN91-5Ann Arbor, MI 48106

O..SP,3; R:JG ',GCiTO2.NG - ' ,.'3) .:Ni1 ADR EE ) 13. 3C">SC, , S- . -SAGENCY F.:C .7 ¶OASD/HA/HSO/RAMS

3 Skyline Place, Suite 1507

5201 Leesburg PikeFalls Church, VA 22041-3203

ii. 31U rLENIErTARiY OE

12a. 01STRi3UTION.'AVAILABIL;TY STAYE2',IE'iT 1_. DST. 3uT C;• COCE

Approved for Public Release: Distribution is Unlimited i

j3. A3STRACT (Nlaxru, ",'.

This document presents the methodology and data employed in updating DoD MedicalTreatment Facility (MTF) peer groups. Peer groups were originally constructed inthe development of a Diagnosis Related Groups (DRGs) based resource allocationmethodology using FY 1986 data, and subsequently updated using FY 1988 data. Thecurrent focus is upon updating the peer groups using FY 1990 data; however, somemodification of the methodology was performed in order to accommodate availabledata. FY 1990 peer groups resulting from the new data and methodology are presented.and compared to the FY 1988 peer groups.

II. SU31ECT TERMS J . 4 L'ABER CF PAGESMTFs; DRGs; Peer Groups 25

! z.. 3C2: CODE

'7..... "'" Q\2;,:E'c.-':EJ '-' ci :3 'Ecc:'L;! CL ::.~ .: .-.," ; .•3. i 2,.c 3¼,,:

"C:F 'qEPCV; ' FT: -:,•C z.,; -,..

UNCLASSIFIED UNCLASSIFIED UNCLASSIFIED UL" " "; - 1 " • i J • .:- - . . :

FOREWORD

Th-s document presents the methodology and data employed in updat-

ing DoD medical treatment facility (MTF) peer groups. Peer groups were

originally constructed in the development of a diagnosis related groups

(DRG) based resource allocation methodology using FY86 data, and sub-

sequently updated using FY88 data. The current focus is upon updating

the peer groups using FY90 data: however, some modification of the

methodology was performed in order to accommodate available data. FY90

peer groups resulting from the new data and methodology are presented

and compared to the FY88 peer groups. This document was prepared under

contract MDA903-88-C-0417. Questions or comments regarding this docu-

ment should be directed to LTC Stuart Baker, OASO(HA) Resource Analysis

and Management Systems, (703) 756-1918.

: L• t

K' '.

ii

CONTENTS

Section PL

1.0 INTRODUCTION ................... ........................ 1-1

2.0 METHODOLOGY .................. ......................... 2-1

2.1 Medical Center Peer Grouping ....... .............. .. 2-12.2 CONUS Community Hospital Peer Grouping ... ......... ... 2-22.3 Overseas Hospital Peer Grouping .......... ............ 2-5

3.0 FY90 PEER GROUPS ..................................... .. 3-1

iii

LIST OF EXHIBITS

Number Title

2-1 Summary of FY86. FY88, and FY90 Medical CenterPeer Group Definitions 2-3

2-2 Summary of FY86, FY88. and FY90 CONUS CommunityHospital Peer Group Definitions 2-6

2-3 Summary of FY86. FY88, and FY90 Overseas HospitalPeer Group Definitions 2-8

3-1 Summary of FY90 Peer Group Definitions 3-2

3-2 Medical Centers Grouped by FY90 Peer Group 3-3

3-3 CONUS Community Hospitals Grouped by FY90 Peer Group 3-4

3-4 Overseas Hospitals Grouped by FY90 Peer Group 3-9

1-1

1.0 INTRODUCTION

This working note presents the methodology and results for updating

DoD medical treatment facility (MTF) peer groups, using FY90 data. The

methodology is based upon an approach employed by the government in the

course of developing a diagnosis related groups (DRG) based resource

allocation methodology1 . As the name implies, a peer group is a set of

facilities which are similar to each other, according to specified

characteristics. The characteristics employed in the original DoD peer

grouping analysis were:

"* location;

"* teaching status;

* relative case-mix index (RCMI); and

* size (where MTF size was defined as the number of operatingbeds).

The original DoD analysis employed FY86 data. Vector Research,

Incorporated (VRI) subsequently updated peer group definitions using

FY88 data2 in the course of refining and updating the ORG-based resource

allocation models. That analysis revised peer group definitions, in

addition to updating the peer groups with FY88 data.

In addition to using more recent data, the current analysis also

revises peer group definitions to employ average daily patient load

(ADPL) in defining MTF size, rather than operating beds. This revision

lFiscal Year 1989 Diagnosis Related Groups Based ResourceAllocation Guidance, Memorandum from ASD(Health Affairs) to theAssistant Secretary of the Army (MERA), Assistant Secretary of the Navy(MERA), and Assistant Secretary of the Ari Force (R), 5 August 1988.

2Analysis of DoD MTF Peer Group Consistency, VRI-HMS-1 WP9o-1,J. Coventry, J. Hufford, C. Roehrig, Vector Research. Incorporated,15 January 1990.

1-2

was born out of necessity, due to the fact that information on operating

beds is no longer available. The focus of the current analysis is not

on developing a new peer grouping methodology, but rather on maintaining

the basic peer group definitions as closely as possible to the existing

ones. Nevertheless, because ADPL was adopted as the facility size

measure, replacing operating beds, new peer group definitions were

required. The approach adopted for determining these definitions

closely followed that documented in developing the FY88 peer group defi-

nitions. While FY90 Uata were the principal information used, FY88 and

FY89 data were also examined to support the analysis. Finally, it

should be noted that where RCMI is referenced, it is the RCMI based upon

the version 4.0 grouper and DRG weights.

This working note contains two further chapters. Chapter 2.0

discusses the methodology involved in updating and revising the peer

groups. Chapter 3.0 presents the peer groups resulting from applying

the peer group definitions to FY90 data. Finally, note that the focus

of this study is upon inpatient facilities, and that while clinic peer

groups do exist, they are not part of this analysis.

2-1

2.0 METHODOLOGY

The first step in defining peer groups was to separate MTFs into

three sets, according to location and teaching status:

. medical centers;

• CONUS community hospitals; and

. overseas hospitals.

The more detailed peer group definitions of facilities within each of

these broad categories will be discussed in the next three sections.

Section 2.1 discusses medical center peer grouping. Section 2.2 pre-

sents CONUS community hospital peer grouping. The final section pre-

sents overseas hospital peer grouping.

2.1 MEDICAL CENTER PEER GROUPING

FY86 and FY88 medical center peer group definitions did not rely

upon MTF size. Therefore, the fact that ADPL replaced operating beds as

the measure of facility size did not require new peer group definitions.

The FY88 medical center peer group definitions were identical to those

developed by the government with FY86 data. These definitions were

based upon RCMI alone, and are presented in the table below.

FY86 AND FY88 MEDICAL CENTER PEER GROUP DEFINITIONS

PEER GROUPA

MC1 < 1.20MCZ 1.20 <- RCMI < 1.50MC3 >- 1.50

2-2

For the current study, medical centers were sorted by FY90 RCMI. and

this list examined in order to determine whether the cut points were

still valid. The examination revealed that these cut points occurred at

natural breaks in the medical center RCMI data; therefore, they were

maintained. A summary of the medical center peer group definitions and

the size of each peer group in FY86. FY88, and FY90 are presented in

exhibit 2-1.

2.2 CONUS COMMUNITY HOSPITAL PEER GROUPING

In the FY88 analysis, there were no natural cut points in either

operating bed size or RCMI to use in defining peer groups. Therefore.

the principal adopted was that of keeping balance in the peer group

size. There were two basic steps in the FY88 CONUS community hospital

peer grouping methodology:

"• determine quartiles based upon operating beds: and

"* determine RCMI cut points which divide each of the quarters inhalf.

The peer group definitions resulting from this approach for FY88 are

presented in the table below.

2-3

EXHIBIT 2-1: SUMMARY OF FY86, FY88, AND FY90 MEDICALCENTER PEER GROUP DEFINITIONS

NUMBER OF MTFs

PEER GROUP RCMI FY86 FY88 FY90

MCi < 1.20 7 7 6

MC2 1.20 5 RCMI < 1.50 6 6 7

MC3 >= 1.50 5 5 5

2-4

FY88 CONUS COMMUNITY HOSPITAL PEER GROUP DEFINITIONS

Peer OperatingS Beds RWEM

CHl-88 < 20 < .75CH2_88 < 20 >- .75CH3_88 21 -40 < .80CH4._88 21- 40 >- .80CH5-88 41 - 80 < .85CH& 88 41 80 >- .85CH7_88 >- 80 < .90CHS_88 >- 80 >- .90

Because ADPL. rather than operating beds, was the facility size measure

adopted for the FY90 analysis, these definitions could not be directly

adopted in determining FY90 peer groups. Therplore. the two steps iden-

tified above were carried out on the FY90 data in order tc determine the

appropriate ADPL quartiles to use in defining FY90 peer groups.

FY90 Biometrics data were used in computing MTF ADPL for CONUS com-

munity hospitals (FY90 Medical Expense and Performance Reporting System

(MEPRS) data were not available it the time of this study). These facil-

ities were then sorted upon ADPL. These lists were then examined in

order to determine whether there were any natural break points in the

data in regions close to the qudrtiles. In order to divide the dita in

half, ADPL from the 40th to the 60th percentiles were examined. The

most promising cut point in this region was ADPL of 25 (this ADPL was

just at the midpoint of the data). The FY88 and FY89 MEPRS data ADPL

supported this choice of a midpoint.

2-5

One promising cut point in the 75th percentile region was 60.

Again, the MEPRS ADPL for FY88 and FY89 supported this choice. The

choice of a cut point for the 25th percentile was not straightforward.

The ADPL in the region from the tenth percentile to the 40th percentile

only range from 10.5 to 15.6, with no large breaks. Therefore, the FY90

ADPL closest to the 25th percentile was chosen: an ADPL of 12.

Tn dividing each of the quarters thus derived into two peer groups,

the FY88 RCMI cut points were employed. Therefore,

"* for the first quarter, the RCMI dividing point was .75;

"* for the second quarter, the RCMI dividing point was .80:

"* for the third quarter, the RCMI dividing point was .85; and

"* for the fourth quarter, the RCMI dividing point was .90.

The eight resulting CONUS community hospital peer group definitions,

together with the FY86 and FY88 peer group definitions, are displayed in

exhibit 2-2. along with the size of each peer group.

2.3 OVERSEAS HOSPITAL PEER GROUPING

The FY88 overseas hospital peer groups are displayed in the table

below:

FY88 OVERSEAS HOSPITAL PEER GROUP DEFINITIONS

Peer OperatingBoe80 .75

0S1-88 < 50 < .75

0S2_88 < 50 >- .750S3_88 >- 51 < .900S4_88 >- 40 >- .90

2-6

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2-7

As with CONUS community hospitals, one component of the overseas hos-

pital peer group definitions in previous peer grouping efforts was

operating beds. Therefore, new definitions involving ADPL were devel-

oped in this analysis. Overseas hospitals were sorted by ADPL and this

list examined for naturally occurring break points in the ADPL. There

was a relatively large gap in FY90 Biometrics ADPL occurring between

22.5 and 36.1 ADPL, which divided the overseas hospitals roughly in

half. Similar gaps existed in the FY88 and FY89 MEPRS ADPL, and 35

appeared to be the best ADPL in the interval to choose, given all tnree

years' data.

In the previous peer grouping study, an RCMI of .75 was used to

divide the smaller overseas hospitals into two peer groups, while an

RCMI of .90 was chosen to divide the larger overseas hospitals into two

peer groups. These RCMI dividing points were adopted again for defining

peer groups in the current analysis. The four resulting FY90 overseas

hospital peer group definitions and sizes are presented in exhibit 2-3,

along with the FY86 and FY88 peer group definitions and sizes.

2-8

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3-1

3.0 FY90 PEER GROUPS

The FY90 peer group definitions for all facility types are pre-

sented in exhibit 3-1.

Exhibit 3-2 displays medical centers by FY90 peer group, along with

each facility's FY90 RCMI and ADPL, and FY88 peer group, for comparison.

There are six MTFs in the first medical center peer group, seven MTFs in

the second, and five in the third. As the exhibit shows, only one

facility switched peer groups from FY88 to FY89: William Beaumont AMC

switched from the first to the second medical center peer group, as a

result of a rise in its RCMI in FY90.

Exhibit 3-3 presents the CONUS community hospitals, by FY90 peer

group. As displayed in the exhibit, there are:S14 MTFs in peer group CH1_90;

0 10 MTFs in peer group CH2_90;

0 19 MTFs in peer group CH3_90;

. 12 MTFs in peer group CH4_90;

. 11 MTFs in peer group CH5_90:

. 16 MTFs in peer group CH6_90:

0 10 MTFs in peer group CH7_90; and

. 17 MTFs in peer group CH8_90.

In all, 44 of 109 CONUS community hospitals switched peer groups between

FY88 and FY90. Of these MTFs which changed peer groups, 16 switched

based upon RCMI changes alone. Of these 16, twelve were due to an

increase in RCMI. Furthermore, of the these twelve, seven were switches

from peer group CH7_88 to CH8_90.

3-2

EXHIBIT 3-1: SUMMARY OF FY90 PEER GROUP DEFINITIONS

PEER GROUP RCMI

MC1_90 < 1.20 MEDICAL CENTERS

MC2_90 1.20 <= mCMI <1.50MC3_90 >= 1.50

PEER GROUP ADPL RCMI

CH1 < 12 < .75CH2 < 12 >= .75 CONUSCH3 12 <= ADPL <25 < .80 COMMUNITYCH4 12 <= ADPL <25 >= .80 HOSPITALSCH5 25 <= ADPL <60 < .85CH6 25 <= ADPL <60 >= .85CH7 >= 60 < .90CH8 >= 60 >= .90

PEER GROUP ADPL RCMI

OSi < 35 < .75OVERSEAS0S2 < 35 >= .750S2 < ~HOSPITALS0S3 >= 35 < .80

0S4 >= 35 >= .80

3-3

EXHIBIT 3-2: MEDICAL CENTERS GROUPED BY FY90 PEER GROUP

Peer Group MCI_90: RCMI < 1.20

FY88 FY90 FY90

DMISID Facility Name Installation Name PGROUP RCMI ADPL

0027 44 OA*ant Oakland 1A?2 149.2900029 NN san elo, San Diego MCIs8 1.165 393.3510052 Tripler AMC Ft. Shafter MCl_88 1.182 387.249

0055 USAF Med Ctr Scott Scott AFB MCl_88 1.150 106.115

0124 RR4Portsmouth Portsmouth MCLS8.1,039315.274G12S ... madtpnAK~A Ft. Lewis MC 181 1 .138 t 91.25S

Peer Group MC2_90: 1.20 <= RCMI < 1.50

FY88 FY90 FY90


S0014 David Gran~t USAF Med Ctr' Travis AFB.......C2_88 1.285.Z01.9600047 Etse.hower AM*C . . Ft. Gord$on : . C2.8i 1I.38$ 295.0490066 Malcom Grow USAF Med Ctr Andrews AFB MC2_88 1.284 183.940

0067 NH Bethesda Bethesda MC2_88 1.393 271.079

003 UA Med Ctr~ Kels.1er Kfts.1tr kFO MCL_88.1.474 217.0380095. USAF 401d Cr 1Wri .t -Patterson 1iqtt-Patter'son AFB MC Z-09 1.345 190.1970108 William Beaumont AMC Ft. Bliss MCI 88 1.235 306.178

Peer Group MC3 90: RCMI >- 1.50

FY88 FY90 FY90


0022 Ltteraan AMC Presid of S.F. MC3.a 12 235.611

0031 FitZ~iW1*n$ AMC MC3_8 1.0 373.0740037 Walter Reed AMC Washington MC3_88 1.829 667.351

0109 Brooke AMC (JMMC) Ft. Sam Houston MC3_88 1.654 361.847

o011 : VW1f.i• 4liUSAF Med C t ILacklan,d AFB I MC3.,88 1.62g 620,970

3-4

EXHIBIT 3-3: CONUS COMMUNITY HOSPITALS GROUPED BY FY90 PEERGROUP

Peer Group CHI_90: ADPL < 12. RCMI < .75

FY88 FY90 FY90


0007 tkK Maysta Adak A CHI_" 0.688 0.6220011 USAF IRosp1tal Wi~llams Williams AFB C~4L.8 0.645 10.0220012 97th Strategic Hospital Eaker AFB CHl-88 0.715 7.7840015 9th Strategic Hospital Beale AFB CHl 88 0.704 11.74

0019 USAF Hospital Edwards ~ Edwards AFB CH2-98 0~.748 11.9480028 014 Lenoore Lemoo~re.......CJ{3..88 0,742 9.540065 42nd Strategic Hospital Loring AFB CHI_88 0.692 11.9340068 NH Patuxent River Patuxent River CHI_88 0.619 8.055

0012 4 Oth Strategic Hospi:tal K.1. Sawyter AEB CHI-.88 0.689 11.310090.4thMedical Group Seymour Johnson AFB CHI-88 0,727 11.958

0097 USAF Hospital Altus Altus AFB CHI_88 0.739 11.5180111 USAF Hospital Reese Reese AFB CH2_88 0.744 2.192

0114 USAP Hospital Laughlin Lauqtvli AF8 C141_.88 0-672 5.49901127 N14 Oak Harbor Oak H4arbor CH-L.R8 0.663 11.321

Peer Group CH2_90: ADPL < 12. RCMI >- .75

FY88 FY90 FY90


0036 :USAF Hosita~l Dover -Dover AFB CH3_.88 0.758 10.4990046 U$AF Hdspital P~atrick Patrick AES CH*2-8.8 0.974 9.1670054 USAF Hospital Chanute Chanute AFB CH4_88 0.998 9.425

0059 384th Strategic Hospital McConnell AFB CH2_88 0.873 3.797

0063 23rd Medical Gro~up England AFS C42_88 0.889 8.710074 USAF Hospital Columibus . Columbus AFB CH2388 0.891 6.1040087 380th Strategic Hospital Plattsburgh AFB CH2_88 0.837 4.992

0102 354th Medical Group Myrtle Beach AFB CH2_88 0.942 5.797

0115 67th Medical Group Bergstrom AFB C14_-8 0.905 11.1640294 H4avlty AN Ft. Benjamin harrtsof CH2..88 0.20 7.827

-Continued --

3-5

EXHIBIT 3-3: CONUS COMMUNITY HOSPITALS GROUPED BY FY90 PEERGROUP (Continued)

Peer Group CH3_90: 12 <- ADPL <25. RCMI < .80FY88 FY90 FY90


0017 93rd Strategic Hospital Castle AFD C143..88 0.664 14,7530018 ist strate91c Hospital Vande-nbrg AEB CH4 I8 0.794 12.6930020 831st Medical Group George AF8 CH3_88 0.734 12.929

0030 BRH MGAGCC Twenty-nine Palms Twenty-nine Palms CHl188 0.655 13.471

0053 366tt Medical Group Mountain Home 08 CHI-" 0.729 14.8820071379th Strategic Hosp•thl Wurtsith AFB CHI-"8 0.783 13.4160076 351st Strategic Hospital Whiteman AFB CHI_88 0.644 13.948

0084 833rd Medical Group Holloman AFB CH3_88 0.715 14.485

00-81 27h edcal Group Cannon AF8 CH3..&8 0.757 15-0660088 41~6th Strategic Hosit~al Gliffiss AFB C141L8. 0.683 12.8820092 NH Cherry Point Cherry Point CH3_88 0.633 18.6680093 842nd Strategic Hospital Grand Forks AF8 CH3 88 0.678 16.474

0096 US$AF Hospital Tinker Tinker AFD C1430.8 0.740 20. ,7 120101 363rtd Medical Group Sh~aw AFS CH-3_8 0.733 21.9750106 44th Strategic Hospital Ellsworth AFB CH3_88 0.679 21.173

0112 96th Strategic Hospital Dyess AFB CH3_88 0.735 16.800

0114 U .SAF Hospital Hill, W11 AF8* CI- 0.780 19,833M19 90th Strategic Hosptal F.E. Warren AF9 C4i3_88 0.707 15.644

0131 Weed ACH Ft. Irwin CHI 88 0.673 12.460

Peer Group CH4 90: 12 <- ADPL < 25, RCMI >- .80

FY88 FY90 FY90


0001 :Fox AN Redstone Arsenal N4_88 0.947 20.685

001.3 USAF Hosptal Little Rock Little Rack AF8 CH4._88 0.816 14.4820035 NH Groton Groton CH5_88 0.960 13.129

0044 31st Medical Group Homestead AFB CH5_88 0.850 23.896

oo 3"47th ý Mood••AFB..•..ii M• •i~! ... C428_8 0.895 15.2990051 USAF MoSfital Ro~bins Rob~ns AF8 CH2..88 0.813 15.2820058 Munson AH Ft. Leavenworth CH4_88 1.027 15.071

0070 Cutler AH Ft. Devens CH4_88 0.866 18.636

0080 509th Strategfc HospItal Peast AFB CH3_88 0.816 14.419

0081 Patterson AH Ft Monmouthi CHA_88 0.919 14.7480083 USAF Hospital Kirtland Kirtland AFB CH4_88 0.963 19.5480099 NH Philadelphia Philadelphia CH6_88 0.895 13.184

-- Continued--

3-6

EXHIBIT 3-3: CONUS COMMUNITY HOSPITALS GROUPED BY FY90 PEERGROUP (Continued)

Peer Group CH5_90: 25 <- ADPL < 60. RCMI < .85

FY88 FY90 FY90


0003 'Lyster A14 :Ft, Rucker Cff4..O 006 3.000S Ba~ssett ACII Ft,. Wainwright CH,3-.88 0A 7,9 3 1. 4190009 832nd Medical Group Luke AFB CH5_88 0.832 29.921

0010 836th Medical Group Davis Monthan AFB CH5_88 0.821 26.951

00-43 3Z5ttt Medical Grovp Tyndall AFB CH4,. 80 0.842 27-973o04S S6tIh Kedical Group Maedill AF8 CH-o 0s.840 44.0850062 2nd Strategic Hospital Barksdale AFB CH5_88 0.845 31.526

0078 Ehrling Berquist Rgn Hosp Offutt AFB CH5 88 0.805 45.255

0079 5S4th ?t4ý&cal Group Nellis AF8 (14330 0.758 27.4630107 N14 Millington Millington CH::: 03787 .. :9.:

0120 1st Medical Group Langley AFB CH5_88 0.676 35.753

Peer Group CH6_90: 25 <- ADPL < 60. RCMI >- .85FY88 FY90 FY90


0002 Nobi e Af4 'Ft.~ mc~cellan CfI6._8 0.889 3.4

0004 Air University Rgp Hospftal MaXwell AFS CH:6_88 0.944 41.2380008 Bliss AH Ft. Huachuca CH5-88 0.894 34.726

0016 USAF Hospital Mather Mather AFB CH5_88 0.907 31.510

0021 zznd Strateqlc Roptl~a~rch AF8 CI4&8.8 0.9ss 50.2790G33 USAF Academy Hospital 0SAF Academy (45_88 0.8S1 41.9620069 Kimbrough AH Ft. Meade CH6_88 1.038 40.364

0086 Keller AH West Point CH5_88 0.866 41.036

0094 857th Strateg•,c Hospital M nt, A•8 CH4_88 0.853 26.723

0100 NH Kiport Newport (1488 0.986 37.9780104 NH Beaufort Beaufort CH6 88 0.921 32.970

0118 NH Corpus Christi Corpus Christi CH4 88 1.041 29.586

0121 MC0~rneld AN Ft Eustis CH6..8.8 0.883 34.0360122 Konsp#r Atf Ft. Lep C146-88 0.899 41.151.0126 NH Bremerton Bremerton CH8_88 0.890 56.789

0128 92nd Strategic Hospital Fairchild AFB CH3_88 0.850 28.238

-- Continued --

3-7

EXHIBIT 3-3: CONUS COMMUNITY HOSPITALS GROUPED BY FY90 PEERGROUP (Concluded)

Peer Group CH7_90: AOPL >- 60. RCMI < .90

FY88 FY90 FY90DMISID Facility Name Installation Name PGROUP RCMI ADPL0006 USAF H4osptal Elmendorf Elmendorf AF8 CHR&8 0.8f*9 60.1290023 R~ay s. H Ft. Old CfiL88 0.826 98.G140032 Evans AH Ft. Carson CH7_88 0.827 98.6360039 NH Jacksonville Jacksonville CH7_88 0.891 90.112004 Wnn AH Ft teW~a-i.rt CHS-88 M.02 71.0410057 Irwin AM F. Ri 1y.* CH7_R89 0.842 81-8680061 Ireland AH Ft. Knox CH7_88 0.892 96.1700064 Bayne-Jones AH Ft. Polk CH5_88 0.775 67.227

0 .1 10 DPaVra AN Ft,. Rood CI{7..8 O.745 153.540*.123 bowitt AR F~t. R lvoir. CI45-88 080 612353

Peer Group CH8_90: ADPL >- 60, RCMI >- .90

FY88 FY90 FY90DMISID Facility Name Installation Name PGROUP RCMI ADPL0024 NN~. Camp P~endleton 'Cam~p Pendleton CH&088 0.909 106.877

NH Lonq Beach Long Beach CI&88 1.181 99.86,0038 NH Pensacola Pensacola CH8_88 1.030 75.4110040 NH Orlando Orlando CH8_88 0.905 78.658

*0042 USAF" Agn Kos P It al .E 9`` 1 Eglin AF .9 CHL188 M392 102.0990(48 ar•tI•n AH Ft. Bennf¶ C H_88 1.029 159.1150056 NH Great Lakes Great Lakes CH8_88 1.143 71.5290060 Blanchfield ACH Ft. Campbell CH7 88 1.026 116.0740076 Wood AH: Ft. Leonard Wod CHL788 0.910 103.8220082 WaltoftAN, Ft. Dix CHS-88 0.947 61.0470089 Womack AH Ft. Bragg CH7_88 0.913 190.0520091 NH Camp Lejeune Camp Lejeune CH7_88 0.904 97.784

0098 Rey,.#M t i CH7_88 097 97.8380 10.3 MH ha1s4 Chrl est" C4788 0.922 106.7290105 Moncrlef AH Ft. Jackson CH8_88 1.011 103.3970113 USAF Rgn Hospital Sheppard Sheppard AFB CH8_88 1.151 94.534

0116 Rtobert Thompson $trategfc Hosp, Carswell AF8 CH$&.88 1.019 86.466

3-8

Of the remaining 28 MTFs changing peer groups between FY88 and

FY90. four would have switched peer groups due to changes in RCMI alone,

but also changed due to changes in the facility size measure:

"• 379th Strategic Hospital at Wurtsmith AFB switched from CHI_88to CH3_90;

"• 92nd Strategic Hospital at Fairchild AFB switched from CH3_88 to

CH6_90;

"* NH Groton switched from CH5_88 to CH4_90; and

"* NH Bremerton switched from CH8_88 to CH6_90.

The remaining 24 changes are not necessarily directly attributable

to changes in facility size, because a different facility size measure

was employed in this analysis. For these facilities, there may have

been no change in either real facility size or facility behavior between

FY88 and FY90: the change in the data used to measure facility size may

have been the sole reason for the facility changing from one peer group

to another. At most it seems that there may have been a change in

relative facility size. Of all 28 changes attributable, at least in

part, to changes in facility sizes, 18 switched to peer groups character-

ized by larger facilities, and ten switched to peer groups characterized

by smaller facilities.

Exhibit 3-4 shows the overseas hospitals divided into peer groups.

There are four overseas hospital peer groups, with:

"* eight facilities in OSI_90;

"* twelve facilities in 0S2_90;

"• seven facilities in 0S3_90; and

"* ten facilities in 0S4_90.

3-9

EXHIBIT 3-4: OVERSEAS HOSPITALS GROUPED BY FY90 PEER GROUP

Peer Group S0190: ADPL < 35. RCMI < .75

FY88 FY90 FY9O

DMISID Facility Name Installation Name F, OUP RCMI ADP'

0617 NH Nals Raples 0S2.88 0.747 21.06

0623 V4 Keflavik W-lad8.8 0.68a 2.310624 BRH USNAF Sigonella Italy OSI. _88 0.646 1.258

0626 USAF Hospital Bitburg Bitburg AB OSi_88 0.672 10.282

0627 US&AF Hospital Hahn Hfahn.AB OSL-8-8 0,64? 10.5210629 USAF Hospital La.es Lajfrs Fild OSI-8 0 674 7.0440632 USAF Hospital Upper Heyford RAF Upper Heyford 0S2_88 0.729 18.233

0639 432nd Medical Group Misawa 051_88 0.670 14.268

Peer Group 0S2_90: ADPL < 35. RCMI >- .75

FY88 FY90 FY90


0603 USA1I Berlin #*r 11n GS2R80 0.879 29.9610604 2nd Field Hospital Areeirhaven 0, 0.785 22.3150611 45th Field Hospital Vicenza 0S2_88 0.767 10.838

0614 196th Station Hospital Shape Belgium 0S2_88 0.826 11.819

0~611 N4 Guantanamo~ ffay Guantanamo 90~ GSZ_80 0.75 657""G•H•N• R..se.el t Roadis. Ceiba OS2" 0,.874 22..040630 USAF Hospital Torrejon Torrejon AB 0S2_88 0.769 17.06

0631 USAF Hospital Hellenikon Hellenikon AB 0S2_88 0.827 0.586

0635 USAF Hospital Incfrltk Incfrlik AS......02-.88 0.845. 14.74*0637 Sth Medical Group Kunisan AB......... 0S 1.112 2.5970638 51st Medical Group Osan AB 0S2_88 0.833 6.466

0640 475th Medical Group Yokota AB 0S2_88 0.801 20.581

Peer Group 053_90: ADPL >- 35. RCMI < .90

FY88 FY90 FY90


0606 130th Statton fspital I4eidel erq, OS3_8 0.815 64.805

0609 670 Evacuation Hojpftal :r g0$ 0.725 47.4""0619 NH Subic Bay Subic Bay 0S3_88 0.839 37.293

0620 NH Guam Agana 0S3_88 0.844 41.622

0621 NH Okinawa Okinawa DS3..88 0.824 96.4360622 NH N~xkoukd Yokosuka . .S3-88 G. 877 .44.91?0633 USAF Rgn Hospital Lakenheath RAF Lakenheath 0S3_88 0.794 36 077

-- Continued --

3-10

EXHIBIT 3-4: OVERSEAS HOSPITALS GROUPED BY FY90 PEER GROUF(Concluded)

Peer Group 0S4_90: ADPL >= 35, RCMI >- .90

FY88 FY90 FY90


0601 :$34tIý General lspftal ý.Augsburg OS?$O 0.914 39.364060Ž Ith Gene~ral Hospital Zad cannstatt GS4_U G.967 92.9860605 97th General Hospital Frankfurt 0S4_88 0.972 142.463

0607 2nd General Hospital LandstuKl 0S4_88 1.122 172.101

.6$ 980b General Ho~spital Nuernberg GS3_" 0.979 90-112061Z 121st Evacuatfon Ho~spital. Seoul...... OS4...88 () 971 98.178.0613 Gorgas ACH Gorgas OS4_88 1.062 89.441

0618 NH Rota Rota OSI_88 1.149 41.811

0628 OSkF Rg ?ted Ctr WJiesbaden WiesbanIen AB rIS4_" 1,047 5-2G636 13th He'dical Center Clark AS 0$4_U L1.12 112,62.1

3-11

Seven overseas hospitals switched peer groups between FY88 and FY90.

Five of these changes were attributable to changes in RCMI alone. One

change, NH Rota, was due to a change in relative facility size. The

final change, 34th General Hospital in Augsburg, was due solely to a

change in the relative facility size measure.

li 118 31illllll!llllllll~lll decembr 199 - dtic · "ad-a256 118 vri-dmis-2.60 j....

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